‘Amer. J. Orthopsychiat. 61(1), January 1991 FORENSIC PSYCHOLOGICAL EXAMINATION OF THE CHILD WITNESS IN CASES OF ALLEGED SEXUAL ABUSE Herbert N. Weissman, Ph.D. The examination of child wimesses in cases of sexual molestation involves com- plexities at psychological and legal levels and requires rigorous analysis and assessment to safeguard the rights and interests of the alleged victim and of the accused. Legal, procedural, and psychological issues are reviewed, and a meth- odological strategy for the investigation and evaluation of child sexual molesta- tion is outlined. Boxe science methodology has been brought productively to bear upon questions associated with psychological ex- amination and testimony in cases of alleged child sexual abuse. A large body of well- focused literature has resulted, with con- ceptual and empirical findings useful to the legal system. These findings, however, il- lustrate the limits of knowledge in this re- cently identified and exceedingly complex area of psycholegal inquiry. They counsel caution at all levels, from the initial inves- tigation of the alleged abuse, to the evalu- ation of the context and chronology of the charge/complaint, to the assessment of com- petency to testify, of genuineness of the allegation, and of impairment and future need. Until recently, little was known concern- ing the prevalence of child sexual abuse. Societal awareness of this historically un- disclosed problem, along with mandatory reporting laws, came gradually to produce increased incidence both of reportage and of societal response. The incidence of sex- ual abuse in the United States was esti- mated at 1.87 per 10,000 children in 1978, 5.76 in 1980, 9.0 in 1982, and 15.88 in 1984 (Thoennes & Pearson, 1988). The sensibilities of concerned persons have been shocked by what many consider a na- tional crisis. Findings have also accumu- lated concerning the incidence of unfounded and fictitious reportage. These findings have been similarly alarming (Besharov, 1985; Coleman, 1989; Jones & McGraw, 1987; Raskin & Yuille, 1987) Many are struggling with complex issues of definition, incidence/prevalence rates, le- gal standards and rules for admissibility, as well as with establishing appropriate meth- ods and procedures for investigating charges and for examining clinical effects of child sexual abuse. However, these efforts are being thwarted by unresolved conceptual and methodological issues. Progress is also being deterred by a “crisis mentality” that has developed in some sectors. Responses to complex social problems made under con- ditions of crisis tend to be more reflexive A revised version of a paper submitted to the Journal in February 1990. The author is in the Department of Psychiatry, School of Medicine, University of California, Davis 48 © 1991 American Orthopsychiatric Association, IneHERBERT N. WEISSMAN than reflective. Questions that would oth- erwise be viewed as empirical in nature, thus requiring research and scholarship, be- come polemicized, reduced to argument, and answered by the stronger or more vis- ible of the contending factions. A more re- flective context, grounded in reasoned in- quiry, tends by contrast to support the development of well-formulated theory and scientific data, which could ultimately find expression in sound public policy. An analysis of the issues that pertain to examining child victim witnesses requires a review of pertinent legal standards for ad- judicating sexual abuse charges. It also re- quires a review of the behavioral science knowledge base in terms of concepts, meth- ods, and data that experts have available to them. This knowledge base will be re- viewed here in the context of pertinent le- gal standards. GENERAL CONSIDERATIONS Legal standards and respective probative levels set broad parameters for the intended psycholegal examination. They thus pro- vide a structure for establishing the meth- odology and for identifying and gathering the legally relevant evidence and data req- uisite to addressing psycholegal test ques- tions, Complexities, however, are many due to the multiplicity and vagueness of statu- tory definitions of abuse. Complexity is compounded by the fact that the court must determine the competency to testify of young children who commonly are the only eyewitnesses to their maltreatment and also key witnesses in their own abuse actions Further, the court must ascertain whether abuse has occurred and whether harm has occurred as an element of abuse The multiple legal standards in this area of the law suggest multiple dimensions of potential clinical involvement. Framed in the form of psycholegal questions, clinical examiners may be called upon to assist the fact finder in determining a) competency to testify, b) culpability, c) liability, and d) proximate harm. Further, assistance may 49 be sought in determining whether ¢) the charge is reliable, fictitious, or unfounded; J) there are legally relevant preexisting dis- orders; g) legally relevant coexisting or in- tervening stressors are present; h) multiple interviews and examinations or other non- legally relevant influences have distorted findings; i) the effects of protracted litiga- tion have resulted in deception or increased impairment. In civil litigation, if harm is found, then additional psycholegal ques- ns require clinical expertise pertaining to differential j) diagnostic, k) prognostic, and 1) dispositional determinations (Weissman, 1985, 1990). Regardless of the type of litigation pur- sued, whether civil, criminal, or both, stress factors associated with protracted litigation result. Negative effects of protracted litiga- tion include multiple opportunities for dis- tortion in recall and contamination of find- ings. A child of four years of age at time of an alleged abuse, for instance, may be more than half again as old and at a different developmental stage at the time of resolu- tion of the criminal, civil, dependency, or custody proceedings. During this extended period, multiple interviews, advice, ques- tions, and examinations by well-intended but variably trained interested parties take place with law enforcement and social ser- vice personnel, physicians, mental health examiners and therapists, lawyers, teach- ers, and parents and other relatives. Satisty- ing the elements of legal standards can thus be compromised. It is well recognized that competency varies as a function of chrono- logical age and developmental stage. It is equally recognized that the ascertainability of guilt, liability, or damages varies as a function of a) the amount of time that lapses, b) the number and nature of devel- opmental and circumstantial events that tran- spire, c) the number and quality of exami- nations that occur, d) family dynamics and pathology, and e) psychosocial influences available to alter the child’s recall of the alleged abuse.50 EXAMINATION OF THE CHILD WITNESS. (CHILD COMPETENCY Four capacities are generally required to establish competency (Bulkley, 1988; CA Evidence Code; Melton, 1981): the capac- ity to perceive facts accurately (e.g., men- tal capacity at the time of instant occur- rence to observe or receive accurate impressions of the occurrence); the capac- ity to recollect and recall (e.g., memory sufficient to retain an independent recollec- tion of the observation); the capacity to un- derstand the oath (e.g., capacity to differ- entiate truth from falsehood, to comprehend the duty to tell the truth, and to understand the consequences of not fulfilling the duty); and the capacity to communicate based on personal knowledge of the facts (e.g., ca- pacity to communicate the memory of such observation, and to understand simple ques- tions about the occurrence). Developmental considerations are criti- cal to the determination of a child witness's competency to testify. Chronological age, level of psychosocial functioning, and men- tal and emotional status, as well as the na- ture and quality of family dynamics and family involvement, hold decisive influ- ence on the young child’s capacity to sat- isfy elements of the competency standard. The interview context itself can be deter minative. Children's interpretations of the language and perceived demands of an in- terviewer can alter perception and eventual recall. King and Yuille (1987) pointed out that the most counterproductive interview- ing occurs when the interviewer has a strong preconceived notion of what occurred, an agenda that the child is implicitly asked to endorse. White, Santilli, and Quinn (1988) argued that investigative independence and technical neutrality are essential compo- nents of a useful examination. The cognitively preoperational child (ages 2 to 7) is highly suggestible and possesses fragile and inefficient memory functions. As a consequence of this, recall of the in- stant occurrence is susceptible to distortion and contamination through incorporation into memory of postevent information (Ceci, Ross, & Toglia, 1987; Goodman & Reed, 1986; Loftus & Davies, 1984). Concepts of time and sequence and of kinship relation- ships are but marginally developed in the preoperational child, thus frustrating ef- forts to determine when events may have occurred, whether multiple instances had occurred, or the circumstances surrounding the alleged abuse. Limited linguistic skills and developmentally immature logical op- erations compound this, and impede com- munication at all levels. Memory retrieval consists of free recall and recognition, the former being more specific to age. Memory processes in the preoperational child are inefficient due to limited mnemonic skills, rapidly fading memory traces, limited selective attention, and lower levels of comprehension associ- ated with a limited knowledge base (Quinn, 1988). Because of the paucity of free recall memory in young children, leading ques- tions are commonly applied in order to en- hance recall and recognition. However, lead- ing questions incur the risk of distorting recall in children highly susceptible to the influence of suggestion, particularly to sug- gestion of adult authority figures to whose perceived wishes they seek to conform. Re- search findings thus indicate that suggest- ibility is high, and that reliability and amount of memory for an event are low in the younger child. Efforts to “prepare” chil- dren in order to enhance the accuracy of their testimony may therefore have serious consequences. Instead of increasing accu- racy, such efforts incur the risk of altering recall by reinforcing and shaping the child's responses ‘The memory process may further be sep- arated into stages of acquisition, retention, and recall. In the younger child, the frag- mentary information that is perceived be- comes encoded into memory and, as with adults but more so, is imperfectly retained. Information that is later retrieved may be compromised by multiple influences that transpire during the period of time between the event and its eventual recollection. Lof-HERBERT N. WEISSMAN tus and Davies (1984), based on research. on suggestibility and malleability of mem- ory, stated that witnesses” reports consist of a blend of information that they may them- selves have experienced, coupled with new details provided or constructed in the course of questioning. Such information, included in misleading/leading questions, becomes integrated into the person's recollection of the event, thereby supplementing or alter- ing the memory of that event. Joined in the report may also be information from dreams that can be confused with information from true perception. Once alteration occurs, it is very difficult to induce a witness to re- trieve the original memory. The eyewitness identification literature il- lustrates how stress, as well as passage of time, corresponds to increases in distortion in the recall of events. Personal needs, bi- ases, emotions, and social expectations in- fluence what is recalled: gaps are filled and inconsistencies eliminated (Blau, 1984; Kassin, Elisworth, & Smith, 1989). De- spite the occurrence of these constructive and reconstructive mnemonic processes, in- dividuals nonetheless tend over time to be- ‘come increasingly certain regarding the ac- curacy of their memories (Loftus, 1979). Memory distortions may thus serve to ob- fuscate causal relationships due to the elab- oration and consolidation of cognitive, mo- tivational, and attitudinal response sets (Sherrod, 1985; Weissman, 1990). There is a small but growing body of re- search pertaining to factors that mitigate dis- tortion and suggestibility and thereby en- hance the accuracy of children’s perception and recall of events. Findings from these studies are mostly ambiguous and contradic- tory, however, due to differences in research questions, methodologies, and populations studied. More systematic and ecologically valid research needs to be conducted before results can be reliably generalized to child sexual abuse cases. Findings on young chil- dren do suggest that: a) accuracy is greater for events that fall within the realm of their understanding and experience, but dimi 51 ished for events that are unfamiliar, uninter- pretable, or emotionally distressing; b) re- call is better for information relating to actions than to static phenomena, such as time, place, person, or kinship patterns; c) they are more resistant to suggestion involv- ing central or concrete rather than peripheral or abstract features of events; d) they are more capable of describing a sequence of events, such as repeated abuse by a familiar perpetrator, than a specific instance; e) ac- curacy of recall is enhanced when free recall rather than question formats are employed (Berliner, 1988; Goodman & Reed, 1986; Poole & White, 1990). With respect to understanding the oath and speaking the truth, there is no way to be certain whether or not a child is lying. Children are capable of dishonesty just as adults are. According to Berliner (1988), sorting out inadvertent or understandable errors from deliberate or malicious false- hoods by the child is not always possible. Research evidence from classic studies by Hartshome and May (/928), and from a line of research on moral development and moral reasoning that followed (Kohlberg, 1969, 1976; Piaget, 1932) is on point. Moral reasoning is viewed developmen- tally as passing through a series of stages, with each stage representing a qualitatively different organization and pattern of matu- rational thought from the preceding one Addressing the generality or specificity of honesty, Hartshorne and May studied con- sistency of children in different situations that involved telling the truth. They found that honest-dishonest behavior varies as a function of situational influences and of the ‘motivations and constraints involved. This suggests that an observer cannot pre- dict accurately what a child’s unanalyzed behavior will be in one situation where hon- esty is at issue, as distinct from the same child’s behavior in another such situation It cannot be held that such behavior ex- presses itself invariantly across situations, as it would if it were the consistent mani- festation of a stable and generalizable per-— sonality trait. With maturation, greater de- grees of consistency emerge. Kohlberg characterized children under nine years of age as in the stage of preconventional thought, in which society's rules and ex- pectations are not yet internalized. Actions and judgments in this stage tend to be ego- centric and governed by external and prag- matic consequences. The issue of credibility is often raised in this context, but not very usefully, because the term implies conscious motivation to- ward honesty or deception. Developmental capabilities as they relate to competency requirements, as well as motivational and situational factors, are more useful explan- atory concepts. They permit the examiner to address the child’s understanding of the oath and of truth or falsity by assessing cognitive and psychosocial dimensions in the context of environmental influences. Fur- ther, these concepts facilitate assessment of a given child’s cognitive capacity to per- ceive, to comprehend, to recollect events and to communicate on the basis of present awareness of these events. A child who lacks requisite capabilities or whose recollection of events has been compromised by moti- vational or situational factors is not a com- petent witness. Independent sources of cor- roborating evidence therefore become critically important bases for establishing culpability or liability. PROFILE VALIDITY Mental health professionals may be called upon to give opinions as to whether abuse has occurred and whether harm exists as an element of abuse. Controversial methods associated with “profile validity” are some- times applied, where the expert testifies as to the characteristics of abused children, or the characteristics of child abusers. Testi- mony addresses an assumed match between these characteristics and the alleged victim in the former circumstance, or the defen- dant in the latter circumstance. Efforts to establish profile validity involve drawing EXAMINATION OF THE CHILD WITNESS. inferences about individual events on the basis of group data. The psycholegal literature illustrates the kinds of misconceptions that are common in this regard. Foremost among these is that there exists some form of valid, generally accepted profile of the child victim and of the child offender. There is none (People v. Ruiz, 1990; State v. Rimmasch, 1989). No reliable constellation of historical, demo- graphic, personality, or other factors has been found that accurately characterizes either the child victim or the child offender. Neither is there any reliable psychological or physiological test or method for deter- mining whether a child has been sexually abused or whether someone has committed an act of sexual abuse (Berliner, 1988; Mel- ton, Petrila, Poythress, & Slobogin, 1987). A diverse array of symptoms is found in a relatively small percentage of molested children, ranging from negligible distress to severe disturbance. Symptoms com- monly mentioned include fear, anxiety, de- pression, anger, withdrawal, sexual preoc- cupation or precocity, and school and sleep difficulties. Symptoms, however, do not im- ply etiology, and no symptom constellation has been found sufficiently and substan- tially associated with sexual abuse so as to constitute a syndrome. All of the charac- teristics enumerated have also been found to be commonly present in child popula- tions with no history of sexual abuse. There- fore, behavior assumed by some to be in- dicative of sexual abuse may in fact be so related, but may also be attributable to nor- mal developmental variations, emotional or physical abuse, neglect, family conflict and parental discord, and modeling behavior im- itative of adults observed in person or on videotapes or television (Bulkley, 1988; Mel- ton & Limber, 1989) PREDICTION OF IMPAIRMENT A significant portion of the abused pop- ulation shows no symptoms in either the short or the long term, thus presenting to the examiner in ways indistinguishable fromHERBERT N. WEISSMAN their nonabused counterparts. This finding makes it all the more difficult to separate reliable from fictitious reports of child sex- ual abuse. Absent a cognizable syndrome, there is no basis for predicting future im- pairment or therapeutic/dispositional need with requisite degrees of certainty. This is particularly true in cases where a cogni- tively preoperational asymptomatic child (below age seven) complains of abuse in the absence of corroborating data, Such is frequently the case. Given the unreliability of assessment of past and present abuse, the problems in evaluating the likelihood of fu- ture impairments are obvious (Melton er al., 1987). An unusually good study by researchers affiliated with the Division of Psychiatry at the Tufts New England Medical Center (1984) examined the initial effects of abuse on children (infancy to 18 years of age) who had been sexually victimized or re- vealed their victimization within six months prior to the study. Seventeen percent of 4— 6-year-olds met the criteria for clinically significant impairment, demonstrating on standardized measures more overall distur- bance than a normal population, but less impairment than other children their age who were in psychological treatment. The high- est incidence of impairment was found in the 7-13-year-old age group. with 40% scor- ing in the seriously disturbed range. Few of the adolescent victims exhibited significant psychological impairment except on a mea- sure of neuroticism. Research literature suggests that child sex- ual abuse has long-term effects in a portion of the populations studied. In retrospective and clinical studies of long-term effects, depression is the symptom most commonly reported among adults molested as children (Browne & Finkelhor, 1986). Studies also identify symptoms that include anxiety, poor self-esteem and impaired interpersonal and sexual adjustment. However, although vie~ tims as a group were found to exhibit a greater degree of impairment than their non- abused counterparts, less than 20% evi- 53 denced serious psychopathology (Browne & Finkethor; Tufts, 1984). Such studies im- ply that there is no presumptive basis for predicting impairment in the long term, par- ticularly when none is found in the short term. Prediction of future impairment involves an assessment of the differential impact of an event on a given child. It is erroneous to assume that abusive experiences will have the same effect on all children. The nature, severity, and context of the abuse; past his- tory of maltreatment; developmental level; family dynamics; psychosocial vulnerabil- ity; and coping resources are among the factors to be considered. MEDICAL FINDINGS The dearth of control-group research has misled professionals in terms of assump- tions and conclusions. The usefulness of medical findings is illustrative here. Until very recently there was no information on the genitourinary and perianal anatomy of children who have not experienced sexual abuse. Hence, medical assumptions about specific characteristics of sexually abused children were made in the absence of crit- ical normative base-rate information. Stud- ies by McCann, Voris, and Simon (1988); McCann, Voris, Simon, and Wells (/989); Emans, Woods, Flagg, and Freeman (/987); and Coleman (1989) indicate clearly that there is a wide range of variability within normal populations. Many of these norma- tive variations have led medical examiners erroneously to conclude that their findings were consistent with signs and symptoms of sexual abuse. Their findings were instead consistent only with normal variations. None- theless, such statements by medical or men- tal health examiners have been responsible for criminal prosecution and civil litigation, RELIABILITY OF REPORTAGE Lack of common definitions of abuse and of standardized outcome and comparison measures, as well as variably trained and marginally competent examiners, have en-54 EXAMINATION OF THE CHILD WITNESS cumbered the process of inquiry. Sexual abuse varies widely from single episode, unlawful touching to protracted episodes of victimization. The kinds of overt abuse that appear to be potentially most detrimental are experiences involving father figures, genital contact/penetration, and force (Browne & Finkelhor, 1986). Indirect al- beit significant abuse also derives from lack of parental support when suspicions arise, emotional overreaction by primary care- givers, effects of multiple invasive exami- nations by multiple examiners, and the pro- traction of litigation. Research has been done on the extent to which allegations of sexual abuse are reli- able, fictitious, or unfounded, based on case- workers’ assessments of whether such ac- counts are convincing in their detail or appear to contain deliberate falsification, misperception, or confused interpretation of nonsexual events; unfounded accounts are those where insufficient information exists for authorities to pursue the charges (Jones & McGraw, 1987), Besharov (1985) found that 65% of all reports of child maltreat- ment (both physical and sexual) were un- founded or unsubstantiated, Jones and Me- Graw, in a study of all reports made to the Denver Department of Social Services dur- ing a one-year period, noted that 53% were considered reliable; of these, 9% were re- cantations, thus reducing the total to 44%. The balance consisted of unsubstantiated re- ports, 8% of which were classified as fic~ titious. In light of these findings, which indicate that more than half of such reports are unsubstantiated, examiners and policy makers must exercise special caution to avoid violating critical rights that are at stake in the areas of child welfare, family pri vacy, and personal liberty (Melton & Lim- ber, 1989). Clinical characteristics commonly found to be present in fictitious reports include absence of detail, use of developmentally inappropriate adult language, lack of au- thenticity in expression of emotion or thought content, absence of coercion or threat in the child's account, inconsistent or contradictory statements, repetitive or rote statements, and preexisting impairment due to prior sexual or physical abuse or neglect, emotional trauma, or personal conflict (Jones & McGraw, 1987; White et al., 1988). In Gardner's (1987) view, the like- lihood of false allegations increases signif- icantly when parental alienation is present, especially in the context of a child custody dispute or litigation. In the Jones and Me- Graw study of sexual abuse reports, more than three times as many fictitious reports of such abuse were made by adults (on be- half of their children) than were made by the children themselves. EVIDENCE Rules of evidence have arisen in re- sponse to the need to establish legal bound- aries and thresholds for admissibility and to accord proper weight to expert testimony. The impetus for this derives from the need of the courts to be assisted by expert testi- mony that is relevant, possesses reliable and valid foundation, contains probative value that outweighs its prejudicial impact, and does not unduly invade the province of the body (i.e., jury) or person properly charged with trying the facts of the case (U.S. v. Kozminsky, 1987). Ethical and professional standards require that experts function com- petently and only within the limits of their expertise and knowledge base. APA's Eth- ical Principles (American Psychological As- sociation, 1981) state that psychologists must avoid exceeding the boundaries of their professional role and obligate psycholo- ists to “avoid any action that will violate or diminish the legal or civil rights of cli- ents or of others who may be affected by their actions.” Suitable testimony would, in order to be consistent with these standards, describe and explain the child’s functioning. Ultimate opinion on whether the defendant is guilty of abuse and on whether a particular child has been abused or has told the truth would be reserved for the trier of fact (Bulkley,HERBERT N. WEISSMAN 1988; State v. Rimmasch, 1989). Expert testimony would inform the body trying the case as to data and concepts and would, to the extent relevant, provide alternate expla- nations that possess reasonable scientific cer- tainty. The Kelly-Frye rules limit testimony to theories, diagnoses, and techniques that pos- sess sufficient scientific basis to have gained general acceptance within the scientific/ professional community of their origin, and whose foundations possess demonstrable and significant degrees of reliability and valid- ity for the purpose to which they are being applied (Frye v. U.S., 1923; People v. Kelly, 1976). The use of anatomical dolls for purposes of diagnosing sexual abuse fails this standard (In re Amber B., 1987). Sex- ually anatomically correct dolls were not designed to diagnose sexual abuse and have not been validated as useful in this regard Diagnoses of sexual abuse syndrome, based on profile validity, also fail this stan- dard (In re Sara M., 1987; State v. Rim- masch, 1989). Most courts have admitted expert testimony on typical behavior of child sexual abuse victims, or dynamics in child sexual abuse cases, as circumstantial proof that a child was abused. However, most courts have not permitted expert testimony concerning abuse syndrome, or an expert opinion as to the child’s credibility or truth- fulness. Doing so is viewed as invading the province of the jury, improperly bolstering the victim's credibility, creating an aura of reliability, and prejudicial to the defendant (Bulkley, 1988) INVESTIGATION AND EVALUATION Consistent with the degree of complexity defined in legal standards, components of the examination involve equivalent com- plexity. Diagnostic examinations address el- ements of the competency standard. They also address validity of the report, as well as genuineness and substantiality of claimed impairments. Diagnostic, prognostic, treat- ment, or other dispositional determinations may be made. 55 ‘The reasons for the complexity of the assessment process are found in issues of research and theory that have been referred to above. They involve a) the need to pro- tect the rights and best interests of young children as well as of the accused; 5) the high rate of unfounded (and to a lesser de- gree fictitious) reports; c) the absence of profile validity, there being no reliable child abuse syndrome nor child molester syn- drome; d) the absence of standard and re- liable specialized measurement instruments for determining abuse; e) developmental im- ‘maturities in the young child, causing mem- ory to be highly susceptible to distortion from the effects of postevent suggestion, and causing other inefficiencies associated with undeveloped cognitive, psychosocial, and communication skills; f) the fact that a large percentage of children who have been molested may exhibit no proximately caused clinical impairments and, conversely, that unmolested children may present with clin- ical impairments that can be misattributed to sexual abuse; g) the difficulties inherent in assessment of future impairment, requir- ing that prediction as well as postdiction be performed with utmost caution; h) the fact that reports are often made in the absence of independent evidence to corroborate the allegations of young children; i) distortions and deceptions in self—or other—presen- tation, associated with prior victimization, personality disorder, or family dynamics, and governed by motivations to obtain ex- ternal incentives. In this, perhaps more than in any other area of psychological examination, the cli- nician must possess intensive and extensive levels of training, experience, skill, and pro- fe nal discipline. Requisite to perform- 1g comprehensive evaluations is special- ed training and knowledge in child de- velopment, psychopathology, personality the- ory, child abuse, family dynamics, and psychological assessment, as well as in clin- ical and forensic psychology. Expertise is required in clinical interviewing and psychological testing in order for data de-56 rived therefrom to be integrated meaning- fully with other sources of information, and brought to bear upon elements of the legal standards. Required also are knowl- edge of behavioral science research and the- ory relating to normal development, of the psychometric properties of tests and mea- sures, of the cognitive and psychosocial de- velopment of children, and of relevant legal standards. RECORDATION OF DATA In this, also more than in any other area of psychological examination, the initial charge and the ensuing investigations of that charge are critical to all else that follows. Reasons for this were discussed earlier. Leading/misleading questions may impart information that becomes incorporated into memory which can remain permanently al- tered. The accuracy of a child’s account and the validity of a child's allegations can thus be irreparably compromised. The fact that a child is not a free agent calls for interviewing family members or collaterals in order to assess genuineness and substan- tiality of charges and complaints. In order to safeguard details of the initial interviews and examinations, they should be memori- alized through means of audio or videotape recording. Doing so potentially limits the need for multiple and repeated examina tions, which can be stressful and can con- taminate the data. SECONDARY TRAUMA AND PROPOSED HEARSAY EXCEPTIONS On the assumption that child victim- witnesses are traumatized by testifying in court, especially in the presence of the ac- cused, hearsay exceptions and the use of protective measures have been proposed in several jurisdictions. Psychological re- search has studied the capabilities of chil- dren to testify and the emotional effects of their involvement in the legal process. In its amicus brief to the U.S. Supreme Court in State v. Craig, the American Psychological Association (APA, 1990) concluded that: EXAMINATION OF THE CHILD WITNESS intrusions on defendants’ rights under the Con- frontation Clause should be applied only on a case- specific basis, where necessary to protect individual child vitim-witnesses. (p. 3) The bases for this conclusion are found in research evidence indicating that whereas children as a class may be especially likely to be emotionally distressed by courtroom confrontation with their alleged abusers, a substantial number of children are capable of testifying without serious and lasting harm. There is also evidence that children benefit from a sense of control and of per- ceived justice acquired through testifying on their own behalf. Doing so therefore can have potentially positive effects (Melton & Limber, 1989). While there is some basis for determin- ing which children are most in need of such protection, knowledge remains sparse about which procedures are most likely to ame- liorate harm, and whether civil proceedings differ from criminal proceedings in this re- gard, Goodman’ preliminary findings (cited in. APA’s amicus brief) indicate that chil- dren are most adversely affected by testi- fying when they have to do so repeatedly in cases where abuse was severe, maternal sup- port was lacking, and corroborative evi- dence was absent. Distressing effects can be reduced by limiting the number of ex- aminations, examiners, and appearances and by providing a supportive context. Another reason to limit the number of examinations and court appearances is to reduce oppor- tunities for data to be distorted either through repetition or because of distress. Suscepti- ble to being altered, findings may become irreparably distorted, resulting in guilt or innocence never being established and vic- timized children being neither protected nor therapeutically assisted PROPOSED INVESTIGATIVE STRATEGY Reported abuse should and often does result in efforts to safeguard the child and screen the charges for credibility. If they are found to be substantial, medical and ‘mental health examinations would soon fol-HERBERT N. WEISSMAN low, with data and evidence memorialized and protected from contaminating influ- ences, Relevant dispositional recommenda- tions would follow. If treatment is initiated, dual relationships would be avoided and tech- nical neutrality preserved. Comprehensive mental health examina- tion would utilize: a) biohistorical and case- specific interviewing of relevant parties, b) observation and mental status examination, ) psychological assessment, d) empirical and research-based data, and e) record re- view to appraise complaints, impairments, pre-post functioning and level of psychoso- cial adaptation. It is essential to clarify de- tails of the complaint; chronology of the charges; history, sociometry, and sequence of reportage; the circumstances under which any prior examinations occurred (e.g., frequency, participants, dates, techniques employed), and the feedback derived there- from. History and influence of overstimu- lation, past maltreatment, and exposure to sexually explicit materials and to other possible perpetrators are assessed (Quinn, 1988), as are birth and developmental history and family relationships and dy- namics, It is often useful to examine level of cog- nition, speech and language, emotional de- velopment, and play. Play materials may be utilized to maintain attention span, to promote interaction with the assessment en- vironment, and to facilitate observation of level of adaptive functioning as may be re- vealed in fear, distress, inhibition, affec- tive intrusion on play, or fantasy reenact- ment. The age and developmental level of the child will dictate differential suitability of clinical procedures. Several assessment sessions are needed without parents or oth- ers present. CONCLUSION The mental health professional has the opportunity to benefit the factfinder by pro- viding comprehensive, technically neutral, independent examinations in cases where child sexual abuse is charged. Using mul- 57 tiple sources of data, opinions may be for- mulated that coherently address elements of pertinent psycholegal standards. Experts are obligated to practice within the limits of their competence and within the bounds of their knowledge. Though growing rapidly, the knowledge base pertaining to the child victim as witness remains limited, thus sug- gesting caution at all levels. Critical issues pertaining to the interests of vulnerable chil- dren and the rights of the accused are at stake. Both demand the highest respect and protection. REFERENCES In re Amber B. (1987). 236 Cal. Rptr, 623. 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